Last month, Public Health England launched its high-profile campaign ‘Keep Antibiotics Working’ to tackle the threat of antibiotic resistance – and encourage patients to trust their doctor’s advice when it comes to not prescribing antibiotics.
As GPs, we all know the risks of unnecessarily prescribing antibiotics to children. It could leave them at risk in the future of more serious infections that are difficult to treat. Antibiotics can also have serious side effects such as nausea, vomiting, diarrhoea, and bloating or stomach pain. So, this new campaign is a positive step.
But it seems more work needs to be done to specifically ensure that children with asthma are not unnecessarily prescribed antibiotics. Recent research by Erasmus University, in Rotterdam, has found that children with asthma are more likely to be prescribed antibiotics compared to children without asthma.
It indicates that healthcare professionals are mistaking asthma symptoms as a respiratory tract infection. It revealed that most of the antibiotic prescriptions given to children with asthma were intended to treat asthma attacks or bronchitis. This is despite the fact that current guidelines do not recommend automatically prescribing antibiotics after asthma attacks because they’re rarely associated with bacterial infections.
Moreover, if children are wrongly prescribed antibiotics, it means they are not being given the correct treatment for their asthma. This puts them at a greater risk of having a potential fatal asthma attack.
How to recognise asthma
The challenge is that both asthma and bacterial chest infections can result in children sounding chesty, having sputum, and chest sounds that can mimic bacterial infections. So, how can GPs tell the difference and ensure they are treating their child patients correctly?
1. Check the colour of their sputum
When you’re seeing a child patient who comes in with chest infection symptoms, listen to their chest, take a temperature and ask more questions, including about the colour of the sputum to help identify whether a bacterial infection might be present.
In a bacterial infection sputum is likely to turn green, whereas if the patient has a viral upper respiratory tract infection, they are likely to have clear or yellow sputum and experience other symptoms such as a runny nose or congestion, ear and sinus problems and an absence of focal chest signs.
2. Ask the right questions
By asking your patient or their parent the right questions you can ascertain if they have, in fact, been having an asthma attack, not a chest infection.
Ask if they have found it difficult to speak, eat or sleep? Is their inhaler failing to help? Is he or she experiencing coughing, breathlessness, wheezing or tight chest? Is their breathing getting faster?
These are all signs of an asthma attack. If your patient feels worse when using their inhaler, have taken ten puffs of their inhaler and don’t feel better - or it hasn’t lasted for four hours - or are worried at any time they should go to A&E.
As a GP, you should send your patient to A&E if they have a peak flow measure of less than 33% than their best (if measured within the last two years) or a predicted, oxygen saturation of less than 92%. Also, if they have altered consciousness, exhaustion, cardiac arrhythmia, hypotension, cyanosis, poor respiratory effort, silent chest, or confusion.
Bear in mind that your patient may have asthma but not yet be diagnosed so you should ask questions of their parent about their history of breathing issues Are months’ worth of ‘chest infections’ in fact signs of asthma? You can find guidance on the best way to diagnose asthma here.
3. Give the right follow up care
If you realise that your patient is experiencing worsening asthma symptoms rather than suffering from a chest infection, make sure you explain this to their parent or carer. This is an opportunity to ensure they are getting the care they need.
All children should have an annual asthma review, be on the right medication, and have an up-to-date written asthma action plan. They should also know how to use their inhaler correctly and, as a GP, you can help them with this technique.
If the patient has had an asthma attack, you should follow up with them after 48hours to ensure that there is improvement. It is important to assess their underlying asthma control, management and self-management to help prevent them from having a future asthma attack.
4. Stand your ground
Parents can often feel helpless when they see their child is unwell and may insist on them having antibiotics. Stand your ground but also make it clear why antibiotics won’t work for their children – and that over-prescribing could cause issues for their child in the future if they develop a resistance when they later need urgent treatment for a more serious infection. There are excellent supporting leaflets from Public Health England that can be shared with patients to help them understand why taking antibiotics when they’re not need puts them at unnecessary risk.
If GPs differentiate between children with asthma and those with chest infections, this will not only help to prevent antibiotics resistance but will ensure children with asthma get the care they need. By preventing asthma attacks, we can save lives.
- Dr Whittamore is a GP and clinical lead for Asthma UK
You can find more information and support for GPs and other healthcare professionals around treating people with asthma at asthma.org.uk/for-professionals